MEDICARE: SONORAN LEARNING AND BEHAVIORAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548789415	OTHER	AZ	NPPES

General Provider Information

NPI Number	:	1821609413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN LEARNING AND BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	23309 N 17TH DR STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-6306
Country	:	US
Telephone Number	:	602-882-4238
Fax Number	:	480-867-0952

Provider Business Practice Location Address
First Line	:	23309 N 17TH DR STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-6306
Country	:	US
Telephone Number	:	602-882-4238
Fax Number	:	480-867-0952

Authorized Official
Title or Position	:	CO-OWNER
Name	:	PAIGE BREEDEN
Credential	:
Telephone Number	:	602-882-4238

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/20/2024

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